Provider Demographics
NPI:1518416205
Name:ANGELL, NANCY LOIS (RD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LOIS
Last Name:ANGELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 KENNETH CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-1307
Mailing Address - Country:US
Mailing Address - Phone:910-297-0656
Mailing Address - Fax:
Practice Address - Street 1:114 KENNETH CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-1307
Practice Address - Country:US
Practice Address - Phone:910-297-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000840133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered